Sex With Emily - How to Have Sex While On Antidepressants

Starting point is 00:00:03 I don't think that you're going to find a brighter, shinier person out there that's going to help you want to have sex again in a way that you want to be having sex because you still love your partner, right? What might be interesting is to find your desire style. What do you need to feel aroused and in the mood? You're listening to Sex with Emily. I'm Dr. Emily, and I'm here to help you prioritize your pleasure and liberate the conversation around sex. Let's talk mental health and sexual desire. Do you really have to choose between one or the other? While antidepressants like Lexapro can be life-saving, all too often, they deflate our sex drive.

Starting point is 00:00:45 But conversely, it's hard to get aroused if your depression goes untreated. So is there any way out of this predicament? Like, you have to be really depressed and not want sex, or you take a pill and you feel better, but then you have a side effect. What to do? Well, on today's show, I'll answer how to overcome this struggle that is way more common than you think. You'll hear from some of our listeners, and I'll also share alternative treatments to hacks around timing and dosage. I'll help you keep pleasure in your life without compromising your mental health.

Starting point is 00:01:21 We can have really strong mental health and a lot of pleasure, promise. Please rate and review sex with Emily wherever you listen to the show. it really helps us get the show out to more people. So whatever platform you're listening on, review the show. Give us five stars. Say something nice. Check out my YouTube channel, social media, and TikTok. It's all at Sex With Emily for more sex tips and advice.

Starting point is 00:01:43 If you want to ask me questions, leave me your questions or message me at sexwithemly.com slash ask Emily. Or call my hotline 559-9-825-5739. Just include your name. your age where you live and how you listen to the show. And you can totally change your name or choose to remain anonymous. All right, everyone, enjoy the show. Okay, so if you've been listening to this show for a while, you know I'm not about random sex toys or gimmicks. I'm about tools that actually support your pleasure, your communication and your connection. That's exactly why we

Starting point is 00:02:24 created the Shop Sex with Emily store. Everything in there is curated by me and my team. And these are products I trust. I recommend to clients and would tell my friends about. I do tell my friends about. It's what I talk about all the time. Whether you're exploring solo pleasure, looking to reconnect with a partner, or you really just want something body safe and beginner friendly? We've organized it so you don't feel overwhelmed. People love the Dane Pillow for Supported Sex, the Magic Wand Waterproof.

Starting point is 00:02:49 Oh my God, it's so good. Cray Vesper, massage candles, Joe flavored lube, We Vibe Touch, clitoral vibrators. There's just so many things on there because pleasure shouldn't be confusing. It should feel empowering. You can check it out at shop. dot sex withemly.com and find something that supports where you are right now or just click the link in the show notes. Also, keep an eye out for curated collections coming soon. All right, I'm going to do things a little differently and I'm going to start off with an email because it really

Starting point is 00:03:22 illustrates the main issue. We've heard a lot from you when it comes to your mental health and treatments. Okay, this is from Sarah 22 in Georgia. Hey, Dr. Emily. I'm a longtime listener of show and I was reaching out because recently I've had some sexual troubles. I'm on antidepressants for my anxiety and it's helping out in so many ways, except sexually. I know it's a side effect of my medication, but my sex drive is so low. I no longer crave sex most of time and I've stopped masturbating as a result. Reaching orgasm was normally easy for me, but it's now difficult to almost impossible. My boyfriend and I've been dating for three years and we usually rip each other's clothes off. Well, I don't want to stop taking my medication, but also don't want to give up my sex life.

Starting point is 00:04:12 Any suggestions? Sarah, you just painted this very common conundrum. Do we have to choose? Can you be on a medication that's helping your symptoms and still want to have sex? Well, let me clarify one thing here. You have been with your partner now for a few years. And so I want to normalize that after a few years, the honeymoon, phase starts to wane, we're just not going to want to rip our partners' clothes off with the same

Starting point is 00:04:40 verb and intensity that we did before the honeymoon phase, or when we were still in the honeymoon phase. Okay. So just normalize that I guess we have to put a little bit more effort in. And I'll share more of this in a few minutes, but sex drive is lower. That is a side effect of taking an antidepressant, especially in SSRI. So just know that once you do get going sexually, I mean, you can get over this lack of just spontaneous desire

Starting point is 00:05:09 of just instantly wanting your partner the second they walk in the room and ripping the clothes off. Like, that's not going to happen. It's not going to happen in longer term relationships and it's definitely doesn't help to be in an antidepressant. I get it's not going to happen spontaneously, but understand what you need to get in the mood for sex. Once you can get yourself going in the mood,

Starting point is 00:05:29 you're going to want to keep going. And it's like it's like going to the gym, you know, sometimes you just don't want to go to workout. And the hardest part is getting on your shoes and getting out the door. But once you get out the door and you've got your workout clothes on, it's a lot easier. So think of your sex life this way. Like, okay, so maybe you're not having that really strong desire, but you need to do things that are to get you there.

Starting point is 00:05:51 Maybe it's sending your partner a sexy text and saying, I can't wait to see you tonight. And I look forward to doing these different things with you. Maybe you guys make out in the morning and you start sending each other sexy text throughout the day building the anticipation for when you see each other later. So it's sort of hacking this typical arousal that you used to feel and desire. And remember, desire and arousal are often used interchangeably. But technically they mean something different, but it's also okay if you could flate them. Desire is the mental. It's the wanting.

Starting point is 00:06:23 It's the desire for sex. It's that thinking about sex. It's that knowing I want to have sex right now. and what I'm asking you to do is think about other ways you can get yourself in the mood so that desire will come. It's not as spontaneous as it might have been in the past. It might be more responsive. Arousal is actually the physical symptoms. Arousal is when your body is showing signs of arousal. Maybe you're getting wetter. There's an erection. Your breath is quickening. Your face is flushing. That's the arousal symptoms. But either way, we tend to use them interchangeably. So all I'm saying is here, we've got to figure out your desire arousal.

Starting point is 00:06:58 and what's going to get you in the mood, because once we get going with sex, once we start to say, like, I'm going to start making out or doing foreplay, you'll find that you will get into the mood with your partner and you will want to have the sex and finish the sex, and you'll be so grateful that you did, much like going to the gym where we don't want to, and then once we get out the door and get to the gym, we're always glad we did. And I, and I'm here to say, I think we're always glad once we get to the sex as well. In fact, I don't think anyone's ever like, why did I have sex last night? Why to have that orgasm? That was terrible. No, we want to do it. What these medication is making us do, it's making us work a little bit harder or a little bit

Starting point is 00:07:37 smarter and sort of hacking our system so we can get to that point of being ready for sex. Okay. So, Sarah, you are so not alone and we're going to get into now how do you balance taking an antidepressants with a healthy sex life? Why is this a common challenge right now? Well, for starters, let me just lay down the facts for you. More people are feeling anxious and depressed than ever before. In fact, the prevalence of anxiety of depression have increased by 25% worldwide in the first year of the COVID pandemic. How crazy is that?

Starting point is 00:08:13 So think about it this way. Pre-pandemic among adults, about 8% to 9% of adults were saying they were feeling depressed. During the pandemic, that number climbed to 32%. That is a massive jump, which means that one in three, one in every three of Americans are experiencing some depression. And as far as anxiety, more than four in ten Americans say they were more anxious than the year prior. Also, more people are suffering from social anxiety after emerging from the social isolations we all experienced during the pandemic, which makes sense. We were not around as many people. We got very comfortable at home and it got a lot harder to get out there and to start talking to people again.

Starting point is 00:08:56 So we have to all go easy on ourselves. And remember this, your sexual well-being is directly impacted by your mental health. If you're not feeling mentally well, well, you're not going to feel as sexually tuned in and turned on. As studied 2020 found there's a decrease in sexual activity in higher rates of sexual dysfunction during the pandemic, largely due to higher rates of anxiety, depression and fear and an uptick in antidepressant and anti-anxiety bed usage. So there's less sex happening, more dysfunction, and they're attributing it to people on antidepressants. But listen, it wasn't just the pandemic. We also saw before the pandemic that sexual dysfunction was prevalent in 62% of depressed men. And then we look at women. And this stat has been around for a long

Starting point is 00:09:44 time that 21% of Volvo owners will experience depression at some point. My belief is that penis owners or men experience depression just as frequently as vulva owners, but maybe they're not as in touch with what it means to be depressed. So I want to normalize that as well. We all know that men are not socialized, talk about their emotions as much. At least they weren't 20, 30 years ago. Hopefully, men of today were raised in homes more open and a lot more support around expressing emotions. But But again, this study has been around forever that twice as many women are depressed of men. And again, I think that it's equal opportunity. We all get depressed.

Starting point is 00:10:22 We're in a conundrum because now that we're treating our depression with the antidepressants, we are having the side effects. So why? Why are an antidepressants causing a low sex drive? Well, the most common is that we're taking these antidepressants, which are SSRIs and SNRIs. But the SSRIs are the ones of their most common that initially they're saying they increases the levels of serotonin in the braid because low serotonin, which is a hormone,

Starting point is 00:10:49 is what's influencing happiness, learning, and memory. And so we have to maintain serotonin levels, which is why SSRIs can be helpful. And when I say SSRIs, it's like all the common ones that you hear of. It's like Sibalta and Prozac and Zoloft and Lexapro. Those are the big culprits. Those are the ones that are the most commonly prescribed and the most common ones that are going to cause sexual side effects. And there's also S&RIs, a serotonin and non-netpreferin re-uptake inhibitor. So these also work on levels of like non-net preference of the brain just to break this down. That's like a fexor. That's Sibolta. Basically, they're the same. Basically, if you're an SNRI or SSRI, the ones that you are most commonly prescribed, you're going to have a sexual side

Starting point is 00:11:36 effect. Now, listen, the reasons are not totally understood since depression. itself can cause sexual side effects. So how do you know? Is it the medication or is it just that I'm feeling depressed? What we do know is that these medications are in place to release serotonin to help with users that are feeling depressed and anxious. And some studies have shown that too much serotonin inhibits a person's sex drive, which is why you're making a harder experience pleasure. So what we're saying is you've low serotonin, so you've got to take a pill it's going to increase serotonin, but when we increase serotonin, you're going to feel happier, but it's going to impact your sex drive.

Starting point is 00:12:19 Another theory is that as your serotonin is increasing, as is these medications, then your levels of dopamine are increasing. And then since dopamine is the chemical we need to feel stimulated sexually, our sex drive is going to decrease. So there's all this stuff happening with your hormones. We want to get this happy hormone in place. It's going to decrease the sex hormone, which I've got to be honest, seems like this really cruel trick in a way. It's like, I'm so depressed, can't get out of bed. The last thing on my mind

Starting point is 00:12:47 is sex. Taking an end ofpressant that makes you feel alive and happy and social and like you want to have sex, but now you can't because of the side effects, which to me, it's just a huge freaking bummer. It's a huge bummer that like, we need dopamine to feel stimulated and then it's going to be decreased. A few months ago, there was a groundbreaking study that came out. Because what we've been told for many, many years. So 30 years, since the 90s, since Prozac and all these other antipressants came out, we were told that somebody who was depressed is having a chemical imbalance. And this chemical imbalance needs to be treated by an antidepressant. Well, these studies that have came out showed that it's actually not true. There isn't a chemical

Starting point is 00:13:33 imbalance. That depression is not caused by low serotonin. But the truth is is that, we have to remember this is that they're not really sure why, and I actually did a big deep dive on this study, they're showing that, well, that might be true. What's also true is that antidepressants do help treat depression and symptoms of depression, anxiety, OCD, eating disorders, and they can be life-saving. So I am in no way saying go off your antidepressants, and I don't think the studies say that either. It's just saying, you know what, the culprit might not be this elusive chemical balance. The culprit might be life of trauma, someone from PTSD, someone who had a really unstable childhood with more trauma than usual, because side note, we all have little messed up things

Starting point is 00:14:21 that happen in our childhood. So it could just be your own experiences in life, which is why there's also been so much talk lately about trauma and treating trauma through a lot of your nervous systems treatments, which is like heat therapy, cold therapy, actually. Acupuncture, exercise, nutrition, therapies like EMDR, eye movement, desensitization, reprocessing. There's a lot of great trauma therapies out there and different kinds of trauma theories that work in the body to release trauma and to release something stored in the body in addition to, in conjunction with antidepressants. So you're on an antidepressant. So what are these side effects everyone talks about? Let me break it down for you.

Starting point is 00:15:06 Volvo owners, 72% had problems with sexual desire, which we already talked about, is the psychological part of Wadi and have sex. That's the part of you that says, I am so horny, I'm so turned on, I can't wait to just rip my partner's clothes off. 72% had increased problems with that. 83% of Volvo owners had problems with arousal. That's physical. That means they weren't getting as lubricated as normal.

Starting point is 00:15:30 Their breath wasn't quickening. They weren't having as many physical symptoms of arousal. And for Volvo owners on SSRI's, 42% had problems with having an orgasm. But let's go to penis owners. Penis owners, their most common sexual side effects from abusing in SSRI is they also reported higher rates of problems with sexual desire and having an orgasm, but lower rates and problems of sexual arousal, which means that men were getting erections, but they weren't necessarily desiring sex or having orgasms.

Starting point is 00:16:03 So they were walking around erect, but not ejaculating, is what I'm hearing from this. But also, because arousal for men, I think you'd be more mental. Like, you can get an erection, right? But the desire wasn't there. But what you got your desire going, you got aroused. But the orgasm wasn't happening. And I've heard this for many. They're like, I'm doing all the things.

Starting point is 00:16:24 I'm having sex with that partner and I'm not coming. Okay. So the antidepressants that are most causing these sexual side effects are the SSRIs, which is like Prozac, Zoloft, Affectsor, Sybulta, Paxil, and of X or XR. So, okay, I've laid the land out for you now. You're realizing that you are not alone, but does this mean that your sex life is over? Does it mean you have to go off of the antipressants? No, I'm not saying that.

Starting point is 00:16:52 Here's some things that you can do, okay? First off, well, listen, even if you are suffering from depression or anxiety, I think this goes for everybody, that the more you can, do more holistic healing practices like acupuncture, breathing, moving your body through exercise, working on healthy nutrition, taking supplements, meditation, yoga, all of these practices absolutely help calm the nervous system. They help you're helping moving your body and they can be a great supplement to any other thing that you're doing to treat your depression and anxiety. You definitely have to consult it with your doctor about all this stuff because SSRIs are

Starting point is 00:17:35 notorious for killing sex drive. You have to remember that only 20% of doctors who prescribe them are even going to tell you about it, which is why a lot of you are not clear. You're like, what happened? I was wanting to have sex all the time, and now I don't. I just want you to understand that your doctor might not be telling you this. So in conjunction to taking a med, try to make sure that you are practicing a healthy lifestyle overall. Here's some things that you can do. always consult with your doctors, you can try switching medications. There's a handful of non-SSRIs out there that have fewer sexual side effects like Wilbutrin or Remeron.

Starting point is 00:18:10 Those are really common. Those are common alternatives to SSRIs to treat depression and anxiety. They don't work for everybody, but you can definitely talk to your doctor about trying another one of these medications. There's also some supplements that have been reported to help with sexual dysfunction, Saffron. That's been one that's derives. from a flower and that can help with aphrodisiac effects and animals and humans and some evidence

Starting point is 00:18:39 that inhibits serotonin reuptake and can sort of help with achieving erection and orgasm in others. Another one is 5HTP. This has been around for a long time. That's another supplement that can be as effective. Some say as SSRIs. Now again, try it out. You got to talk to your doctor about this. I think you have to be really regular with these doses and also try some of the other holistic approaches I talked about for these supplements to work. Okay, but here's some other hacks. If you're staying on the antidepressants and you're like, but what else can I do? I don't want to go off the beds, which I totally understand. Here's a few hacks. Timing. So a lot of patients have noticed that there's stronger side effects right after they take their antidepressants. So if you know you're going to

Starting point is 00:19:30 be having sex? Take your SSRI first thing in the morning, so when you're having sex later that night, the side effects might be decreased. Another one is reducing alcohol. Many, many, many people are quick to blame their SSRI for a lower sex drive when alcohol may actually be the culprit. There was a study that found that 34% of women experienced symptoms of sexual dysfunction, especially a lack of desire and difficulty with orgasm, when they were on an antidepressant and also having a high level of alcohol consumption. They clearly warn you on these antipresents not to drink alcohol, and I'll be honest, very few people read that or adhere to that, but it might not be your antidepressant, it might be your alcohol intake. So as always,

Starting point is 00:20:20 just pay attention to that and reduce your alcohol consumption. Marijuana. A lot of studies lately about marijuana, cannabis, and sex drive. But it seems that at low doses seems to help a sex drive, which I've heard from many's anecdotally and in research that a low dose of marijuana, whether it's like an edible or, you know, another form can sort of help with sex drive. You're kind of decreasing in ambitions and it can help you get more in the mood. Study showed that more than 200 women and men who use cannabis found that nearly 60% said that cannabis increased their design. for sex, which is a great thing. Again, I think it decreases your inhibitions and it allows you to be more in your body and maybe you're less in your head. The flip side of that is that cannabis can

Starting point is 00:21:06 lead some to be more anxious and paranoid, which is not a newsflash here, but if you're feeling a lot more anxious of paranoid from cannabis, you're definitely not going to be as much in the mood. And also, he will experience problems with less motivation for sex, erectile dysfunction, trouble reaching orgasms, or premature ejaculation. Well, it looks like Volvo owners seem to benefit the most with cannabis because in a study, they show that there was a definitive link between cannabis and improved orgasms for Volvo owners. So, perhaps just using your cannabis in the bedroom when you know you're going to have sex might be the sweet spot for many.

Starting point is 00:21:44 But again, check out the side effects, talk to a doctor, try it out, maybe in small doses and see how it goes. I'm also excited to share with you some alternative treatments for depression and anxiety that I've been really fascinated with and I've had some friends and colleagues who have tried it out. And one is called TMS therapy or transcranial magnetic stimulation. What I love is that it's FDA approved as a safe and effective treatment for a major depressive order. Maybe people who weren't responding to antidepressants or just have been depressed for a long time. And essentially what it does is you go to see a doctor.

Starting point is 00:22:17 I think some of these clinics, you go once a day for 40 days, you go and they deliver these electromagnetic micropulses to your scalp. So essentially you're wearing like you lay down on a machine and you're essentially wearing like a scalp mask, a scalp helmet with a lot of different pulses on it. And what it's doing is it's activating regions of your brain affected by depression. So it's a non-invasive form of brain stimulation. And what the cool thing is, it operates completely outside of the body and it's affecting the central nervous system activity by again just applying these powerful magnetic fields to specific areas of the brain. It is shown that this can be more effective for many individuals than any depressants and it does not lead to sexual dysfunction.

Starting point is 00:23:04 It's painless. It's non-invasive. Does it require anesthesia? It just requires a lot of time. Another thing people are asked about with this like, oh, is that like shock therapy, which has been used for many, many years? Shock therapy is still being used, ECT. for electroconvulsive therapy. TMS offers lower, low intensity magnetic pulses. ECT is like shock therapy. You probably heard about this like in the 50s too. Like it is literally shocking your brain because nothing else has worked. So your brain is actually seizing. But with this seizing, it's sort of resetting your brain. And it can help patients with severe major depression. I don't know many people use it, but it can be used for people with very, very severe cases of depression.

Starting point is 00:23:48 All right. Another thing, hallucinogens, aka psychedelics. Now, there's been a lot of great research of recent years that's super, super promising for the treatment of anxiety and depression and PTSD with hallucinogenic psychedelics. So one is ketamine. Ketamine is a dissociative adesthetic and that has been used in small doses, according to a 20-22 study. in the Journal of Clinical Psychiatry, 72% of patients saw improvement in their mood. 38% were depression, symptom-free after 10 infusions. 85% saw decrease in suicidal ideations after only 15 infusions of ketamine. And they didn't have to go back on antidepressions or maybe antipressants weren't even working.

Starting point is 00:24:34 So I think this stuff was really, really promising. MDMA, also a.k.a. Mali or Ecstasy. There was a study that showed that 67% of patients no longer met the diagnostic criteria for PTSD 18 weeks after starting treatment. And then there's psilocybin, which is magic mushrooms. Studies have shown that, again, 71% people who took psilocybin for major depressive disorder showed a 50% reduction in symptoms after only four weeks. I think this stuff is really promising. But let me just tell you this. There is a disclaimer and there's definitely downsides like everything. First, if you find a clinician, please only only,

Starting point is 00:25:14 consult clinicians who are credited by Maps, which is a multidisciplinary association for psychedelic studies. This is one of the only places that I think that are the most reputable if you want to find someone who's worked with maps. Things to know, insurance doesn't cover these type of treatments yet. Hopefully they will. And in fact, maybe in some states they do, but many of them don't. Access is limited.

Starting point is 00:25:39 You have to go to a clinic, enroll in a study, or do it from home. And again, you guys, I've had friends who had some bad experiences. I'm going to be honest. They found an academy clinic, like in their area, and it was just not what they wanted to be. So I just can't emphasize enough that you want to be with a practitioner. And maybe you can talk to some of their clients. Do some research on them. Make sure you are working with somebody who is accredited.

Starting point is 00:26:02 And again, the risk is that in some instances, hallucinogens can evoke a long-lasting psychotic reaction, especially if you have a family history of psychosis. Okay. So really, I just wanted to lay out for you everything that's happening in the space of mental health and wellness and treatments for it. So hopefully that explanation of why endopressants can affect your sex drive. And then some solutions to address the side effect were helpful for you. And please just let me know any questions. Do you have any clarifications?

Starting point is 00:26:31 And if you'd like me to do more episodes on this topic, I would love to. Okay. So you let me know what you need here. This is from Mel, and she's in Los Angeles. Hey, Dr. Emily, I know the difficulty achieving orgasm is a common side effect of antidepressants, especially SNRIs and SSRIs. I've experimented with different endopressant meds and the only ones that help my depression are SNRIs, and they make it much more difficult for me to achieve orgasm.

Starting point is 00:27:06 Never had a problem with orgasming prior to meds. And when I switched off the SNRIs to Welbutrin, I had no issues achieving orgasm, but Wilburgeon didn't help my depression. Side note, I've heard this is very, very common. A lot of people will get switched to a Welbucin. I would say for half people, it really works, but for half people it doesn't work, okay? Is there anything I can do to help counteract this horrible side effect of my SSRIs

Starting point is 00:27:27 and regain my normal ability to orgasm? I appreciate any vice you can give. All right, so yes, I want to help you here, and I want to say a few things. First, the side effects of SSRIs tend to subside over time. They're really intense in the beginning, but for many people, after a few months, they can subside. And a lot of it is mental too. We are like, oh, am I going to be able to orgasm? I get turned on the last few months. I haven't been turned on and aroused. And we continue to perpetuate this, you know, belief. So I think just knowing

Starting point is 00:28:00 that you can figure out a way to break through it is going to help you. You could also try some of the hacks I mentioned above switching up your dose, making sure that you are healthy, that you're exercising, that you're moving your body, that you're eating healthy foods. You know, maybe trying a little bit of marijuana has been helpful for some. The timing of the dosage, like I said, trying different timing of your dosage could be helpful. Masturbation, you guys, listen, you might not be hit over your head with this desire. You might not want to masturbate. You might be feeling like I don't want to have sex.

Starting point is 00:28:31 But sex begets sex, the more you start like trying to work on your desire or to hack your desire. So maybe you start to masturbate. So you remember what it feels like to orgasm even if you don't feel like it. just like you don't feel like going to the gym and you don't feel like taking your Medicaid medicines. There's a lot we don't feel like doing, but can you hear me out that once we started doing it, we're glad we did?

Starting point is 00:28:51 Like I don't think anyone's ever been like, fuck, why'd I have that orgasm last night? Why do I have sex last night? So if you have to do little things to push yourself and to keep going, like with masturbation or toys, start getting you in the mood and get you going, I think you're going to find that your orgasm is going to come back, maybe it'll even come back stronger.

Starting point is 00:29:08 So be willing to do some workaround and some supplemental activities that will help you reach orgasm and more pleasure. Okay, thank you for your question. I really appreciate you. This is from Gemma. She's 28 in London. Hey, Dr. Emily, I need your help.

Starting point is 00:29:25 I booed my partner for a couple years or both on SSRI's antidepressants. Mine's for anxiety. His for OCD. This has taken a huge childhood or sex life as neither has had a sex drive since taking them, but they make our mental health so much better. There are so many societal norms on how often we should be. be having sex, but it's on average happening once a month. That feels that we're doing it just

Starting point is 00:29:46 because we should. We love each other dearly, but if this carries on, I worry we will only become friends. Is there someone out there that will make me want to have sex or this is how it's supposed to be? All right. Well, thank you for your question here. And Gemma, I get it. It is not easy when you're noticing the sudden plummet and changing your sex drive. But the good news here is that your partner's coming right along with you. He's also not feeling it. So how can you guys work together to say, you know what, once a month doesn't quite feel right for both of us. And I kind of agree with you that if you're only having sex month a month with a long-term partner, I feel like we probably need to be doing a little bit more than that. Unless you're both totally fine with it,

Starting point is 00:30:27 but I'm not hearing that. What I'm hearing is that this is a great opportunity for you guys to tackle it together, work together as a couple. I don't think that you're going to find a brighter, shinier person out there that's going to help you want to have sex again in a way that you want to be having sex because you still love your partner, right? Well, it might be interesting is to find your desire style. What do you need to feel aroused in the mood? We have an article five arousal styles and we put that in the show notes. We also have a podcast that explains what's your arousal type and some things in this article thing. And again, you guys, like I said earlier, desire and arousal are very closely linked. I don't think we have to get caught up in it. But

Starting point is 00:31:08 knowing where your arousal slash desire, it's thinking about if desire is like your motivation to have sex, like we're mentally, like, am I in the mood for sex? And how am I going to get aroused to it? Like, what actually happened? So arousal can happen. Like, how do you get to the point of your desire and arousal is through, maybe you can find out, I need conversation. Maybe you know, you know this, that when you have long conversations with your partner

Starting point is 00:31:37 by your hopes and your dreams and, you know, maybe you're more of a sapio-sexual, meaning that You need more of an intellectual conversation to turn you on. That's when you get aroused. Well, maybe you need to build in more of those conversations. Or maybe you find that you get aroused more through touch. The way your partner raises your thigh, gives you a central massage. That's what you need to be moving mood for sex. Or maybe you need visuals.

Starting point is 00:32:00 Maybe you need your partner to send you sexy nudes or you want to watch porn together. Or maybe you want to share some fantasies. Or maybe you need to play. You know, maybe like talking about and planning your feelings. future, like, I can't wait to talk dirty with you or to get dressed up or to do some kinkier things with you is really going to be the thing that will get you guys on the same page. Or maybe you need physical adventure. Maybe the two of you, when you work out together, you go hiking or you're like, you get the

Starting point is 00:32:26 adrenaline going together. Well, couples who get the adrenaline and their heart pounding finds that they're releasing feel-good chemicals in the body, which is prompting them to feel sexual. So you sort of leverage this physical arousal and then enhance the intimacy. between both of you. So really, this is about truly just understanding and sort of it's a hack for both of you. Like knowing that you're both out in the mood, look at this arousal style inventory. We'll put it in the show notes and just figure out what do we both need to get there and then start to work around it so you can both find the pleasure and the desire and the

Starting point is 00:33:06 sex that you both need in the relationship. The other thing that you can do, and this is a really interesting study is that you can prioritize emotional intimacy. Again, emotional intimacy is a prerequisite for physical intimacy, for many, many couples. And there's more couple counselors that are utilizing the 36 questions. There's a study that I find fascinating that's proven to increase closest in couples. So each partner goes back and forth answering questions, and you can do them over a single session or stretch them out over time. And the studies have found that when couples do these 36 questions, they've found to enhance intimacy and arousal and their frequency of sex. So some example of these questions are, for what in your life do you feel most grateful?

Starting point is 00:33:58 Take four minutes and tell your partner your life story as in much detail as possible. Another question is, is there something that you've dreamed of doing for a long time and why haven't you've done it. Another question is, what roles do love and affection play in your sex life? So they found that when couples sit and ground in these 36 questions, that it increases their closeness, it melts way resentments, and couples have found more connected, more intimate, and more ready for sexual intimacy as well. Because again, antidepressants might be wreaking havoc on your body in ways that are negatively impacting your sex drive and your sex life. But all these tools here might help you override the side effects so you could really work

Starting point is 00:34:46 towards closeness and intimacy. Last question is from Courtney. She's 48 in Michigan. Hey, Dr. Emily, I'm 48 years old and I recently started taking Welchran and Lexapro for symptoms of depression, anxiety, fatigue, lack of arousal, energy, brainfrog. From 2010 to 2017, I took Zoloft. When I went off Zoloft in 2017, my sex drive life was reignited. Everything awoke from a slumber I didn't even realize it was in.

Starting point is 00:35:13 It was amazing. This experience made me very reluctant to go back at any meds. But my symptoms were worsening rapidly despite the use of alternative treatments. As feared, the meds have affected every aspect of my sex life and it's so frustrated that they have to choose between mental health and have any enjoyable sex life. Any thoughts, suggestions, or help or be appreciated. Thanks for the work you do. All right, Courtney, I hear you. This is a bummer. So it sounds like you went off of all of your meds and initially you felt really aroused, turned on like you were rediscovering your sex life. But those pesky symptoms were

Starting point is 00:35:48 coming back, which sucks. Sounds like you started feeling anxiety. You started feeling anxious and depressed again. And you went back on the meds. So what to do? Well, first, I just want to say that you're 48 years old, though, that there could be other things going on. And I would definitely find a doctor who specializes in hormone treatment therapy, especially for women's sexual health, and see if there's something going on with their hormones. Because at age 48, I would guess that you're in perimenopause. Paraminopause can last to women anywhere between like eight and 10 years where your body's making a transition to menopause, which is menopause is simply like a day. Like, menopause is when it's a year without a menstrual period. Perimenopause is this treatment that lasts forever. It seems like it's

Starting point is 00:36:28 forever, and women age 10 years, and in that period, all your sex hormones are decreasing. And unfortunately, when you've got estrogen that's taking a decrease in testosterone and you've got to play with your progesterone, what happens is you're starting to have symptoms that are related to anxiety and depression, but it's not in the same way you were having before. So in conjunction to going back on your meds, you might also want to get in some hormone replacement therapy. But again, only if you find somebody in your area that specializes in it, because there's a lot of people who think they do, or there's a lot of different opinions about it. A lot of times our Western doctors like gynecologists are not necessarily up on the latest

Starting point is 00:37:13 treatments. I'm a fan of bioidentical hormone replacement therapy. So I would look to that as well. And another thing I haven't mentioned is nutrition. I don't think as much, but there's a lot of great information lately. Aviva Ram, ROM wrote a great book on hormones, and that kind of talks about, like, it's a multi-discontory approach. We have to, like, there's certain foods we should be avoiding different, you know, supplements we could be taking. There's just a lot to understand about hormones as it relates to your sexual health and your sex drive. And so just becoming an expert in your own sex life and your own challenges right now is really important. It means sometimes we have to become our own very best advocates because I'm telling you in my journey, I've probably

Starting point is 00:37:57 gone to five or six different doctors that I've gotten all this different advice and I really have to pick and pull what worked for me. But, you know, menopause and Sartza women around age 40 to 44 and you're 48 years old. So I'm sorry to say this, Courtney, because it seems like you've been through a lot in all these years, but I would also just add getting successful hormone panels done with the doctor that you trust and working in nutrition. and maybe some hormone replacement therapy as well. And so maybe you'll find that you won't need as much of the antidepressants as you need to supplement some other treatments.

Starting point is 00:38:34 All right? Thank you so much, everybody. Thank you for your questions, your emails, and we'll talk soon. That's it for today's episode. Thank you so much for listening to Sex with Emily. And if you love the show, please like, subscribe, and leave a review wherever you get your podcast. And hey, share this with you.

Starting point is 00:38:58 a friend or a partner. It might just spark something. It usually does. You can find me on Instagram, TikTok, YouTube, Facebook, and X. It's all at Sex with Emily. Oh, and I've been told I give really good email. So sign up at sex withemly.com for free guides and articles and more ways to prioritize your pleasure.

Sex With Emily - How to Have Sex While On Antidepressants

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